National OrganizationNational Organization

For Victim Assistance

Dr. Will MarlingDr. Will MarlingExecutive Executive Director

Championing dignity & compassion

for victims of crime and crisis

Championing dignity & compassion

for victims of crime and crisis

What is NOVA?What is NOVA?

Since 1975

Since 1975

Since 1975

Since 1975

What is NOVA?What is NOVA?

800-TRY-NOVA800-TRY-NOVA

What is NOVA?

NNetworketworkooffVVictimictimAAssetsssets

4

NOVA is the secretariat NOVA is the secretariat

Department of DefenseDepartment of Defense

Sexual Assault Advocate Certification ProgramSexual Assault Advocate Certification Program

(D-SAACP)(D-SAACP)

Currently under developmentCurrently under development

NOVA NOW

NOVA NOW

United States ConstitutionUnited States Constitution

Crime Victims’ Rights Crime Victims’ Rights

Proposed 28Proposed 28thth Amendment Amendment

Thank You!Thank You!

Dr. Will MarlingDr. Will Marling

willmarling@trynova.orgwillmarling@trynova.org

Office: 703-535-6682Office: 703-535-6682

Victim Assistance: 800-879-6682Victim Assistance: 800-879-6682

8

Medical-Legal Partnerships: A preventive

approach to safety and care

Friend Health Connection: Preventing Domestic Violence Among People with Disabilities

Presented by Ben Beck-Coon, JD, MSWMay 17, 2012

9

Session Roadmap Understand the basics of the Medical-Legal

Partnership (MLP) model

Explore the goals and rationale of MLP

Illustrate the model through a case example

Q & A

10

What is a Medical-Legal Partnership?

A partnership between at least one attorney and a healthcare clinic or hospital, whose primary purpose is to serve low-income and other vulnerable individuals

An innovation in healthcare and legal services delivery that integrates legal services into the healthcare setting to address the material hardships associated with poverty and illness, thereby reducing stress and increasing well-being

11

Basic Needs

Safe, affordable housing Personal stability and safety Adequate, healthy food Appropriate Educational Setting Access to Quality Health Care

Source: Lauren Smith, MD MPH – The Medical Legal Partnership for Children

12

Known Threats to Health

Poverty Substandard and Unaffordable Housing Food Insecurity Inadequate Education Exposure to neighborhood and family

violence Barriers to quality in health care

Source: Lauren Smith, MD MPH – The Medical Legal Partnership for Children

13

Issues We Need to Raise… Awareness of the importance of social

factors Recognition that access to health care and

social services is paramount to good health

Realism that resources to overcome social barriers are often beyond the reach of patients and providers

Source: Dr. Rupa Nimmagadda Department of Pediatrics- University of Chicago Comer Children’s Hospital

14

The Result….. Complex, unfamiliar social service systems

make advocacy difficult, inefficient, and ineffective

Social issues seem untreatable Medical treatments and care are

undermined

Source: Dr. Rupa Nimmagadda Department of Pediatrics- University of Chicago Comer Children’s Hospital

15 Source: Cartoon by Jack Maypole, MD, MLP

Boston; Copyright MLP Boston 2009-2010

16

The (traditional) Clinical Team Doctor Nurse Practitioner Nurse Educator Social Worker Registered Dietician Physical Therapist Occupational Therapist Speech & Swallow Therapist Home Nurse

And introducing….

17

The Lawyer and the Medical-Legal Partnership

Lawyers as powerful sub-specialists

Valuable means for effective advocacy

Addresses significance of social factors

Places solutions to social barriers within reach

Increases the return on initial investment

Improves overall health

18

Why integrate legal services in a healthcare

setting? Cultivates a culture of advocacy in health

care institution Promotes one-stop shopping experience in

a clinical setting Builds on patients’ trust and familiarity Enables identification of legal issues

through a preventive approach, decreasing the likelihood of legal (and health) emergencies.

Source: National Center for Medical-Legal Partnership

19

The Unique Role of the Healthcare Provider

Trust is implied Meetings take place in a safe environment The communications are confidential Patients already share many intimate details of

their life with their provider – martial problems, eviction, job loss, school problems Unfortunately, often times providers are not trained as

to what to do when they come upon these issues in their practice

Source: Health and Disability Advocates, Chicago, IL; Diane Pappas UVA Children’s Hospital/Medical-Legal Partnership Training Materials

20

Who are the legal and clinical partners in an

MLP? Legal Partners

Legal Aid Organizations (primary partners) Private Bar Law Firms (different models) Law School Clinicals

Healthcare Partners Hospitals (nonprofit/for profit, public/private) Health Clinics Community Health Centers Federally Qualified Health Centers

21

Core Components of MLP Direct Legal Services

Improving Health Systems Comprehensive training on legal needs and

remedies Enhancing tools for identification Finding better ways to “treat” legal problems

External system change Example: MLP Boston and public utilities

Source: National Center for Medical-Legal Partnership;© 2008-2009 MLP Boston

22

What are the areas of focus?: I-HELP

Income/Insurance Supports Public Benefits Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) Food Stamps Insurance Access and Benefits

Housing Shelter Access Access to Subsidies Utilities

Education Individuals with Disabilities in Education Act (IDEA) ADA

Legal Status Immigration

Personal Stability and Safety Guardianship, Custody, Divorce Domestic Violence Personal Planning Documents (Wills, Powers of Attorney, Living Wills)

Source: National Center for Medical-LegalPartnership;© 2008-2009 MLP Boston

23

A Growing Movement Lawyers and front-line healthcare

providers (doctors, nurses, social workers) are partnered at 225 hospitals and and health clinics in the United States

MLP has been officially recognized by the American Bar Association (ABA) and American Medical Association (AMA)

Recognized as an innovation by the Agency for Healthcare Research and Quality (AHRQ)

Case Example – Jane Jones 45 year old woman with a h(x) of seizures, asthma,

PTSD, major depression, and paranoid schizophrenia

Referred by nurse for housing issues

Client and son being abused by father/husband

H(x) of hospitalizations

A team-approach to Jane’s case

Barriers to care

24

Using a Trauma Framework Shift in conceptualization of “symptoms”

Recognizes the role of violence and abuse in the development of MH symptoms and disorders

Renames symptoms as survival strategies

Destigmatizes symptoms

More balanced approach to treatment

Focuses on empowerment, resilience, hope

25

26

MLP Resources/Contact Info

National Center for Medical-Legal Partnership: www.medical-legapartnership.org

My Contact Info: Benjamin Beck-Coon O: 267.597.3670 bbeckcoon@lcdphila.org www.lcdphila.org